Tepper Stewart J
Cleveland Clinic, Headache Center, Cleveland, OH, USA.
Continuum (Minneap Minn). 2012 Aug;18(4):807-22. doi: 10.1212/01.CON.0000418644.32032.7b.
Medication-overuse headache (MOH) is a chronic daily headache in which acute medications used at high frequency cause transformation to headache occurring 15 or more days per month for 4 or more hours per day if left untreated. MOH is a form of US Food and Drug Administration-defined chronic migraine. This review will describe (1) MOH clinical features and diagnosis, (2) pathophysiology and structural and functional MOH brain changes, and (3) prevention and treatment of MOH.
MOH causes structural and functional brain changes. Any butalbital or opioid use increases the risk of transforming episodic into chronic migraine (sometimes referred to as chronification). The American Migraine Prevalence and Prevention Study demonstrated that transformation is most likely to occur with 5 days of butalbital use per month, 8 days of opioid use per month, 10 days of triptan or combination analgesic use per month, and 10 to 15 days of nonsteroidal anti-inflammatory use per month. Acute migraine treatment should be limited to 2 or fewer days per week, and opioids and butalbital should be avoided.Treatment of MOH consists of combining prophylaxis, 100% wean of overused acute medications, and provision of new acute medications, strictly limiting use to 2 or fewer days per week. Wean can be done slowly in an outpatient setting or it can be done abruptly, sometimes requiring hospitalization with medicine bridges.
MOH development is linked to baseline frequency of headache days per month, acute medication class ingested, frequency of acute medications ingested, and other risk factors. Using less effective or nonspecific medication for severe migraine results in inadequate treatment response, with redosing and attack prolongation, frequently leading to chronification. Use of any barbiturates or opioids increases the transformation likelihood.Patients with MOH can usually be effectively treated. The first step is 100% wean, followed by establishing preventive medications such as onabotulinumtoxinA or daily prophylaxis and providing acute treatment for severe migraine 2 or fewer days per week. Slow wean or quick termination of rebound medications can be accomplished for most patients on an outpatient basis, but some more difficult problems may need referral for multidisciplinary day hospital or inpatient treatments.
药物过度使用性头痛（MOH）是一种慢性每日头痛，其中高频使用的急性药物会导致转变为每月发作15天或更多天、每天发作4小时或更长时间（若不治疗）的头痛。MOH是美国食品药品监督管理局定义的慢性偏头痛的一种形式。本综述将描述（1）MOH的临床特征和诊断，（2）病理生理学以及MOH的脑结构和功能变化，（3）MOH的预防和治疗。
MOH会引起脑结构和功能变化。任何巴比妥类或阿片类药物的使用都会增加发作性偏头痛转变为慢性偏头痛（有时称为慢性化）的风险。美国偏头痛患病率与预防研究表明，每月使用5天巴比妥类药物、8天阿片类药物、10天曲坦类药物或复方镇痛药、10至15天非甾体抗炎药时，最有可能发生转变。急性偏头痛治疗应限制在每周2天或更少天数，应避免使用阿片类药物和巴比妥类药物。MOH的治疗包括联合预防、100%停用过度使用的急性药物以及提供新的急性药物，严格限制使用至每周2天或更少天数。减量可在门诊缓慢进行，也可突然进行，有时需要住院并使用药物过渡。
MOH的发生与每月头痛天数的基线频率、摄入的急性药物类别、摄入急性药物的频率以及其他危险因素有关。使用效果较差或非特异性的药物治疗重度偏头痛会导致治疗反应不足，需要重新给药且发作时间延长，常常导致慢性化。使用任何巴比妥类药物或阿片类药物都会增加转变的可能性。MOH患者通常可得到有效治疗。第一步是100%停用，随后建立预防性药物治疗，如使用A型肉毒毒素或每日预防用药，并每周2天或更少天数为重度偏头痛提供急性治疗。对于大多数患者，减量或快速停用反跳性药物可在门诊完成，但一些更棘手的问题可能需要转诊至多学科日间医院或住院治疗。
